A. The Medicaid Program's diagnostic laboratory services benefit limit and radiology/other services benefit limit each apply to the outpatient setting.
1. Diagnostic laboratory services benefits are limited to five hundred dollars ($500) per State Fiscal Year (SFY: July 1 through June 30), and radiology/other services benefits are limited to five hundred dollars ($500) per SFY.
2. Radiology/other services include without limitation diagnostic X-rays, ultrasounds, and electronic monitoring/machine tests, such as electrocardiograms (ECG or EKG).
3. Diagnostic laboratory services and radiology/other services defined as Essential Health Benefits by the U.S. Preventive Services Task Force (USPSTF) are exempt from counting toward either of the two new annual caps.
B. To request extension of benefits for any services with benefit limits, all applicable records that support the medical necessity of extended benefits are required.
C. Documentation requirements include the following:
1. Clinical records
must:a. Be legible and include records supporting the specific request;
b. Be signed by the performing provider;
c. Include clinical, outpatient, and emergency room records for dates of service in chronological order
d. Include related diabetic and blood pressure flow sheets;
e. Include a current medication list for the date of service;
f. Include obstetrical record related to current pregnancy; and
g. Include clinical indication for diagnostic laboratory and radiology/other services ordered with a copy of orders for laboratory and radiology/other services signed by the physician.
2. Diagnostic laboratory and radiology/other reports
must include:
a. Clinical indication for diagnostic laboratory and radiology/other services ordered;
b. Signed orders for diagnostic laboratory and radiology/other services;
c. Results signed by the performing provider; and
d. Current and all previous ultrasound reports, including biophysical profiles and fetal non-stress tests.
Credits
Eff. Nov. 1, 2006. Amended July 1, 2022.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.2-214.120, AR ADC 016.06.2-214.120
